Q: This question is for Dr. Heltemes. First, great presentation!Many dermatologists (at least mine!!) recommend annual dermatology screenings. Given the genesis and progression of melanoma, do you feel annual dem screenings are still advisable? Or can then they reasonably be stretched out to 24 months? Thanks! Eric H

A: Hello Eric – Glad you were able to listen in! The issue of skin cancer screening is not very well settled, other than for those at increased risk of melanoma. Most organizations do not recommend routine skin exams in those of average melanoma risk simply because it has not been shown with any degree of certainty that it saves lives. But intuitively, it makes complete sense that it might be of use and that the risks of doing so are minimal (other than increased health care costs!).

Those with any increased risk certainly warrant routine exams, with the frequency determined by the degree of increased risk. And one could argue too that being a white male >age 50 is an increased risk. Also any screening exam is likely better by a dermatologist than by a primary care doc.

As for one vs two years, I don’t know of any good comparison. There was a screening trial in Germany that went with two year follow-ups and did not find any reduction in melanoma deaths, but it was only 5 years of f/u and was probably underpowered.

Self-examination may be the most effective strategy – maybe that in conjunction with two year derm screening would be a practical approach?! Best wishes to you, Brad

Q: This question is for Dr Coates: Dr. Coates listed occupations of higher risk. I would be curious of his opinion related to veterinarian profession? I had read an article in a animal magazine that discussed higher rates of suicide or attempts in that occupation population. It was an eye opener to me. Do you have any data that you have seen that supports that?

Dr. Coates: Below are some articles re this –

Journal of the American Veterinary Medical Association

January 1, 2019, Vol. 254, No. 1, Pages 104-112

Suicide among veterinarians in the United States from 1979 through 2015

Suzanne E. Tomasi DVM, MPH; Ethan D. Fechter-Leggett DVM, MPVM; Nicole T. Edwards MS; Anna D. Reddish DVM; Alex E. Crosby MD, MPH; Randall J. Nett MD, MPH

CONCLUSIONS AND CLINICAL RELEVANCE Results of the study indicated that PMRs for suicide of female as well as male veterinarians were higher than for the general population. These data may help to inform stakeholders in the creation and implementation of suicide prevention strategies designed for veterinarians.

A higher-than-expected number of deaths from suicide among veterinarians has been described in multiple studies1–8 from Australia, Norway, and the United Kingdom. In 1982, investigations of deaths due to any cause for US veterinarians who died during the years 1947 through 1977 found that the PMR for suicide among white male veterinarians was 1.7 times that of the general US population.9,10 Another study11 of male and female veterinarians in California who died during 1960 through 1992 determined the PMR for suicide among California veterinarians was 2.6 times that of the general population.

Evidence from surveys of veterinarians also suggests veterinarians have a higher risk of suicide, compared with the general population. In 2014, a survey of 11,627 US veterinarians found 9% had current serious psychological distress, 31% had experienced depressive episodes, and 17% had experienced suicidal ideation since leaving veterinary school12; each of these is a risk factor for suicide13,14 and each was more prevalent than in the general population.15,16 Other regional surveys supported these findings by describing higher levels of anxiety, depression, and compassion fatigue among veterinarians, compared with US regional populations.17–23 Furthermore, a study24 of veterinary surgeons from the United Kingdom found higher levels of anxiety, depression, and suicidal thoughts, compared with the general population.

The 1982 study10 of deaths among US veterinarians included only males, and most of those veterinarians practiced food animal medicine. However, the demographics in the veterinary profession have changed substantially over the past 3 decades. Beginning in the late 1980s, the number of female veterinary students began exceeding the number of male veterinary students.25 In 2017, over 60% of 110,531 US veterinarians were female, and in 2016, approximately 80% of students enrolled at US veterinary medical colleges were female.25,26 Additionally, in the past 50 years, society has moved away from an agriculture-based culture, and companion animals have become increasingly popular.27,28 Since 2007, the number of companion animal practitioners has steadily increased.26 In 2017, > 75% of US veterinarians practicing clinical medicine worked exclusively or predominantly in companion animal medicine.

proportionate mortality ratios (PMRs)

Journal of the American Veterinary Medical Association

October 15, 2015, Vol. 247, No. 8, Pages 945-955

Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among US veterinarians

Randall J. Nett, MD, MPH; Tracy K. Witte, PhD; Stacy M. Holzbauer, DVM, MPH; Brigid L. Elchos, DVM; Enzo R. Campagnolo, DVM, MPH; Karl J. Musgrave, DVM, MPH; Kris K. Carter, DVM, MVPM; Katie M. Kurkjian, DVM, MPH; Cole F. Vanicek, DVM; Daniel R. O’Leary, DVM; Kerry R. Pride, DVM, MPH; Renee H. Funk, DVM, MPH&TM, MBA

Conclusions and Clinical Relevance—In this survey, approximately 1 in 11 veterinarians had serious psychological distress and 1 in 6 experienced suicidal ideation since leaving veterinary school. Implementing measures to help veterinarians cope with practice-related stressors and reducing barriers veterinarians face in seeking mental health treatment might reduce the risk for suicide among veterinarians.

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